NPIMap

Organization Active NPI

B.W. Petkovich, D.D.S., PA

  • General Practice Dentistry
  • Mountain Home, AR
National Provider Identifier
1417268426
Registry record updated Jun 24, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2371 Issued in AR
Legal business name
B.W. PETKOVICH, D.D.S., PA
Practice address
500 Hospital Dr
Mountain Home, AR 72653-2913
Phone
(870) 425-9757
NPI assigned
Jun 24, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Bernard William Petkovich, D.D.S.NPI 1336253582
Title
Dentist
Phone
(870) 425-9757

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 2371 AR Primary

Addresses

Primary practice location

500 Hospital Dr
Mountain Home, AR 72653-2913

Mailing address

500 Hospital Dr
Mountain Home, AR 72653-2913
Phone (870) 425-9757

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1277337600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277337600000",
    "number": "1417268426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 HOSPITAL DR",
            "city": "MOUNTAIN HOME",
            "state": "AR",
            "postal_code": "726532913",
            "telephone_number": "870-425-9757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 HOSPITAL DR",
            "city": "MOUNTAIN HOME",
            "state": "AR",
            "postal_code": "726532913",
            "telephone_number": "870-425-9757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "B.W. PETKOVICH, D.D.S., PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-24",
        "last_updated": "2010-06-24",
        "status": "A",
        "authorized_official_last_name": "PETKOVICH",
        "authorized_official_first_name": "BERNARD",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "870-425-9757",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "AR",
            "license": "2371",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mountain Home, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.